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Health for future: self-rated health and social status among adolescents
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-8216-0344
2020 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Hälsa för framtiden : Självskattad hälsa och social status bland ungdomar (Swedish)
Abstract [en]

The overall aim of this thesis was to explore self-rated health, subjective social status and smoking in adolescents.

This thesis consists of a qualitative and a quantitative study. The qualitative study was an interview study that included 58 participants in the 7th and 12th grades. The cognitive interviewing technique ‘think-aloud’ was employed to explore how adolescents interpret and reason when answering a question about self-rated health (‘A person may feel good sometimes and bad sometimes. How do you feel most of the time?’). Additionally, factors contributing to subjective social status in school and the different strategies adolescents used for positioning were explored. Qualitative content analysis and thematic network analyzes were used to analyze the data. The quantitative study was a cohort study involving 1046 adolescents who answered questionnaires about their health in the 7th, 8th, 9th and 12th grades. Data were used to investigate predicting factors in the 7th grade for smoking in the 12th grade, as well as to examine associations between subjective social status in school, socioeconomic status and self-rated health in boys and girls in the 12th grade. Data were analyzed using chi-square tests, binary logistic regression and ordinal logistic regression analyses.

The results from the interviews showed that participants interpreted the self-rated health question in holistic terms including social, mental and physical aspects. Results from the quantitative study showed that boys rated their health higher than girls at all ages. In a multivariable analysis lower selfesteem, a less negative attitude towards smoking and ever using snus in the 7th grade were significant predictors of smoking in the 12th grade. In addition, girls had an increased risk of becoming smokers. Cross-sectional analyses in the 12th grade revealed that adolescents’ self-rated health was positively associated with subjective social status in school, mood in the family and self-esteem in both girls and boys. Boys rated their subjective social status higher than girls. When exploring subjective social status in school further through interviews, status hierarchies in school were confirmed by the participants, which were strongly influenced by norms linked to gender, age, ethnicity and parental economy, but also expectations about how to look, act and interact.

In conclusion, this thesis demonstrates that the self-rated health question ‘How do you feel most of the time?’ is useful for capturing a multidimensional view of health. Early efforts to strengthen adolescents’ self-esteem, promote anti-smoking attitudes and avoid an early initiation of snus seem to be important components of smoking prevention in adolescence. The positive association between self-rated health and subjective social status in school indicates that the subjective social status question is a useful healthrelated measure of social position in adolescents. Because social desirability in the school hierarchy was defined by norms that left little room for diversity, the possible negative impact of status hierarchies on adolescents’ health should to be considered. Overall, gender differences in health and social status emphasize the need for a gender-sensitive understanding of factors that impact adolescents’ lives

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2020. , p. 87
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2081
Keywords [en]
Adolescent, health, self-rated health, smoking, self-esteem, social status, subjective social status, gender, social norms, think-aloud interview
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-169729ISBN: 978-91-7855-245-0 (print)ISBN: 978-91-7855-246-7 (electronic)OAI: oai:DiVA.org:umu-169729DiVA, id: diva2:1424906
Public defence
2020-09-04, Föreläsningssalen, Falu lasarett, Falun, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2020-04-21 Created: 2020-04-20 Last updated: 2020-04-21Bibliographically approved
List of papers
1. Exploring self-rated health among adolescents: a think-aloud study
Open this publication in new window or tab >>Exploring self-rated health among adolescents: a think-aloud study
2016 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 156Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite extensive use of self-rated health questions in youth studies, little is known about what such questions capture among adolescents. Hence, the aim of this study was to explore how adolescents interpret and reason when answering a question about self-rated health.

METHODS: A qualitative study using think-aloud interviews explored the question, "How do you feel most of the time?", using five response options ("Very good", "Rather good", "Neither good, nor bad", "Rather bad", and "Very bad"). The study involved 58 adolescents (29 boys and 29 girls) in lower secondary school (7th grade) and upper secondary school (12th grade) in Sweden.

RESULTS: Respondents' interpretations of the question about how they felt included social, mental, and physical aspects. Gender differences were found primarily in that girls emphasized stressors, while age differences were reflected mainly in the older respondents' inclusion of a wider variety of influences on their assessments. The five response options all demonstrated differences in self-rated health, and the respondents' understanding of the middle option, "Neither good, nor bad", varied widely. In the answering of potential sensitive survey questions, rationales for providing honest or biased answers were described.

CONCLUSIONS: The use of a self-rated health question including the word 'feel' captured a holistic view of health among adolescents. Differences amongst response options should be acknowledged when analyzing self-rated health questions. If anonymity is not feasible when answering questions on self-rated health, a high level of privacy is recommended to increase the likelihood of reliability.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Self-rated health, Subjective health, Health assessment, Feel, Adolescence, Qualitative, Think-aloud interview, Cognitive interviewing, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-117585 (URN)10.1186/s12889-016-2837-z (DOI)000370407800001 ()26880571 (PubMedID)
Available from: 2016-03-02 Created: 2016-03-02 Last updated: 2020-04-20Bibliographically approved
2. Predictors of smoking among Swedish adolescents
Open this publication in new window or tab >>Predictors of smoking among Swedish adolescents
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2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, p. 1296-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Smoking most often starts in adolescence, implying that understanding of predicting factors for smoking initiation during this time period is essential for successful smoking prevention. The aim of this study was to examine predicting factors in early adolescence for smoking in late adolescence.

METHODS: Longitudinal cohort study, involving 649 Swedish adolescents from lower secondary school (12-13 years old) to upper secondary school (17-18 years old). Tobacco habits, behavioural, intra- and interpersonal factors and socio-demographic variables were assessed through questionnaires. Descriptive statistics, univariable and multivariable logistic regression were used to identify predicting factors.

RESULTS: Smoking prevalence increased from 3.3% among 12-13 year olds to 25.1% among 17-18 year olds. Possible predictors of smoking were: female sex, lower parental education, poorer family mood, poorer self-rated health, poorer self-esteem, less negative attitude towards smoking, binge drinking, snus use and smoking. In a multivariable logistic regression analysis, female sex (OR 1.64, CI 1.08-2.49), medium and low self-esteem (medium: OR 1.57, CI 1.03-2.38, low: 2.79, CI 1.46-5.33), less negative attitude towards smoking (OR 2.81, CI 1.70-4.66) and ever using snus (OR 3.43, CI 1.78-6.62) remained significant independent predicting factors.

CONCLUSIONS: The study stresses the importance of strengthening adolescents' self-esteem, promoting anti-smoking attitudes in early adolescence, as well as avoidance of early initiation of snus. Such measures should be joint efforts involving parents, schools, youth associations, and legislating authorities.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-98496 (URN)10.1186/1471-2458-14-1296 (DOI)000347855900001 ()25518992 (PubMedID)
Available from: 2015-01-22 Created: 2015-01-22 Last updated: 2020-04-20Bibliographically approved
3. Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study
Open this publication in new window or tab >>Self-rated health, subjective social status in school and socioeconomic status in adolescents: a cross-sectional study
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 785Article in journal (Refereed) Published
Abstract [en]

Background: Social position, traditionally measured by objective data on socioeconomic status (SES), is linked to health status in adults. In adolescents, the association is more uncertain and there are some studies suggesting that subjective social status (SSS) might be more adequate in relation to health. This study aimed to examine associations between SSS in school, SES and self-rated health (SRH) in adolescent boys and girls.

Methods: A descriptive cross-sectional research design with quantitative survey data was used. The study involved 705 Swedish adolescents in upper secondary school (17–18-year-olds). SRH was measured with a single-item question and SSS by a question where adolescents were asked to assess their social position within their school. Formal education level of the parents was used as a proxy for objective SES. Univariable and multivariable ordinal regression analyses were conducted to assess the associations between SRH and SSS in school and SES.

Results: In the multivariable analysis, SSS in school was positively associated with SRH, whereas no significant association between SES and SRH was found. The proportion of adolescents with high SRH increased with higher steps on the SSS ladder. Significant gender differences were found in that boys rated their SRH and SSS in school higher than girls did.

Conclusions: The study shows that self-rated health in adolescents is related to perceived social position in school. Subjective social status in school seems to be a useful health-related measure of social position in adolescents.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Adolescents, Gender, Health status, Self-rated health, Socioeconomic status, Subjective social status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-161715 (URN)10.1186/s12889-019-7140-3 (DOI)000472845800005 ()31221114 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, FAS dnr 2009-0292
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2020-04-20Bibliographically approved
4. Playing the complex game of social status in school – A qualitative study
Open this publication in new window or tab >>Playing the complex game of social status in school – A qualitative study
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(English)Manuscript (preprint) (Other academic)
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-169500 (URN)
Available from: 2020-04-02 Created: 2020-04-02 Last updated: 2020-04-20

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